Accreditation Newsletter

HAPPY NEW YEAR!!

Welcome to our New Year edition of Professional Services Network's (PSN) Accreditation Newsletter.

We met many of you in San Diego this past October, while exhibiting and attending consulting sessions at URAC’s 7th Annual Quality Summit & Exhibit. This is the third year PSN has been represented at this important event. The conference gave us an opportunity to absorb new versions of URAC’s clinical accreditation standards, as well as the new AccreditNet application process. We also learned about URAC’s new program of periodic compliance visits. We look forward to sharing these important updates with you.

In this newsletter, we will share a few points that may be helpful to you as you prepare your organization for accreditation or re-accreditation. We are finding lately that organizations frequently request assistance with developing medical management programs, products and services, as well as ongoing evaluation and updating of current programs. In the current competitive marketplace, having best practice medical management products to meet your new and existing client needs are critical for your bottom-line company growth.

Over the last year, we have expanded our network of seasoned national consultant experts (many are former and/or current accreditation reviewers) who have skills and knowledge in program development. They can guide organizations in the development of medical management programs, using national URAC or NCQA standards with industry best practices as a framework for building programs.
We suggest that you use national accreditation standards as a blueprint for your programs, assuring risk management and industry best practice. Build your program from the start with a pre-accreditation focus. Whether or not you choose to obtain national accreditation, you will have the assurance that all systems are in place for accreditation compliance.

We are ready to help you with medical management, program development from inception, or URAC and/or NCQA accreditation initiatives.

We’d be happy to discuss your particular situation with you and describe how we may be able to help.

Please feel free to give us feedback. We'd love to hear from you!

– Peggy Thomas, RN, MS
   Senior Consultant, Accreditation Services
   pthomas@psninc.net
   Phone: 877-753-1776

NCQA: NEW STANDARDS - NEW CHALLENGES
by Ellen Pauley, NCQA Surveyor/PSN Consultant (next) (back)

In 2006 and 2007, the NCQA standards for accreditation and certification underwent significant changes. The areas of change for health plans and disease management organizations are summarized below.

Health Plans

Health plans seeking accreditation from NCQA will now be required to demonstrate that they provide members with information to help them navigate the health care system, and that they have programs in place to promote wellness and manage complex conditions. The new standards, previously part of NCQA’s voluntary Quality Plus program, reflect an increased desire among consumers, employers and plans to involve patients more directly in their care. The changes in the 2007 standards include:

	Integrating Member Connections (MEM) and Care Management and Health Improvement (CHI) standards from Quality Plus into accreditation.
	Adding new standards and measures, including a Physician and Hospital Directories standard and two HEDIS measures, and
	Revising and updating existing standards.

Because of the three year accreditation cycle, many plans will not undergo a survey that includes the new standards until 2008 or after; therefore, NCQA will continue to offer plans the opportunity to undergo voluntary review under the Quality Plus program and achieve distinction in these two areas.

Disease Management (DM)

Disease Management organizations seeking accreditation or certification under the 2006 Disease Management standards are now required to meet strengthened patient privacy and confidentiality requirements and expanded methods of how DM programs identify eligible patients. The 2006 changes include:

	Use of specific data sources, such as claims data, lab results or health risk appraisal results, to identify patients eligible for DM programs. Programs are also assessed for how frequently they survey such data sources for eligible members.
	New requirements regarding confidentiality and sharing of patient information with client organizations. These changes relate to compliance with provisions in the Health Insurance Portability and Accountability Act (HIPAA) and standards in other NCQA Accreditation programs, notably the Quality Plus program.
	New quality improvement measurement standards that require DM organizations to annually assess their performance and identify areas for quality improvement.

The scoring methodology for DM accreditation and certification has been adjusted to make it more consistent with other NCQA Accreditation programs.

How to Best Prepare

Preparation for an NCQA survey can still be a struggle, especially in light of the new standards, but it doesn’t have to be so. Three action items can dramatically reduce the preparation struggle and increase an organization’s success:

1.	Provide adequate resources: NCQA includes standards that address quality improvement, but they also address a number of other areas, too. Areas such as utilization management, provider relations, marketing, informatics, member services and support must be involved. These areas must be supported by senior management and must be afforded the training and time to devote to the survey preparation effort.
2.	You can never start too early: Many standards require an organization to demonstrate compliance over a number of years. It is advisable for an organization to start preparation activities three years prior to a survey. This will afford the organization with time to make sure that structure and processes are in place and that required measurements and improvements can be documented.
3.	*Engage expert help:* Preparation for an NCQA survey requires expertise in NCQA subject matter and complex project management skills. Often times the day-to-day working operations within an organization are all encompassing and do not afford individuals with the time to devote to the NCQA process. If permanent staff devoted to NCQA oversight and preparation is not possible, consider investing in a consultant.

A consultant can establish project plans, interpret the intent of the standards, assess compliance, participate in and coordinate preparation activities, and track time lines and milestones. If considering the use a consultant, make sure that the consultant is an NCQA surveyor. Only an NCQA surveyor will truly understand the NCQA process, the intent of the standards, and the philosophy behind NCQA accreditation and certification.

CONSULTANT SPOTLIGHT (back)

Meet one of our highly qualified consultants.

Kathleen Ward Douglas, RN, MPA, CCM

Kathleen Ward Douglas is a seasoned consultant providing client-specific solutions for Case and Disease Management. Her extensive knowledge and operational experience focuses on designing effective Case and Disease Management strategies for new and existing models for single and integrated programs. Her professional commitment promotes an advocacy model based on patient empowerment resulting in improved clinical and financial outcomes.

Kathleen is an accomplished healthcare executive with over two decades of experience working in profit and non-profit nationally recognized medical/healthcare management organizations. She is highly sought after as both a consultant and public speaker.

Do you have an accreditation-related question that you would like us to address in a future issue?

Would you like additional information about our services?

Send us an email – or call us at 1-877-753-1776.